Examining cognitive disengagement syndrome in a psychiatric outpatient sample: Psychometric support and associations with internalizing symptoms and sleep problems.

OBJECTIVE: The internal (structural) and external validity of a self-report measure of cognitive disengagement syndrome (CDS, formerly sluggish cognitive tempo) relative to a self-report measure of attention-deficit/hyperactivity disorder-inattention (ADHD-IN) was evaluated with adults from university outpatient psychiatric clinics in Turkey. METHODS: A total of 274 outpatients (75.9% women; ages 18-64 years; Mage = 31.06; SDage = 10.84; 50.4% anxiety disorders; 41.6% depressive disorders; 2.9% ADHD; 1.5% sleep disorders; 0.7% eating disorders; 2.9% no mental disorder) completed self-report measures of CDS, ADHD-IN, ADHD-hyperactivity/impulsivity (HI), sleep problems, depression, and stress. RESULTS: All 15 CDS symptoms measured by the Adult Concentration Inventory (ACI) showed convergent (moderate to high loadings on the CDS factor) and discriminant (loading close to zero on the ADHD-IN factor) validity. CDS also showed stronger first-order and unique associations than ADHD-IN with sleep problems, depression, anxiety, and stress, whereas ADHD-IN showed stronger first-order and unique associations than CDS with ADHD-HI. CONCLUSION: This is the first study to provide support for the scores from this 15 item self-report measure of CDS by the ACI in a clinical sample of adults, with findings consistent with previous studies examining parent and teacher rating scale measures with the same 15 CDS symptoms. These findings provide additional support for usefulness of these 15 CDS symptoms as measured by the ACI to study CDS across various cultures.

Efficacy of accelerated deep transcranial magnetic stimulation wi̇th double cone coi̇l in obsessive-compulsive disorder: A double-blind, placebo-controlled study.

High-frequency deep transcranial magnetic stimulation (dTMS) targeting the medial prefrontal cortex (mPFC) and the anterior cingulate cortex (ACC) with an H-coil has received approval from the Food and Drug Administration for the treatment of obsessive-compulsive disorder (OCD). Nevertheless, there is limited evidence regarding the efficacy of a similar procedure performed using a double-cone coil or in an accelerated regimen. In this study, patients in the active TMS group (n = 14) underwent stimulation of the mPFC and ACC twice daily at a frequency of 20 Hz for three weeks, using a double-cone coil. The same procedure was applied to the control group (n = 15) using a placebo coil. Throughout the study, the patients continued their antidepressant and/or antipsychotic treatments at the same dose. Following treatment, the active TMS group exhibited a more significant reduction in Yale-Brown Obsessive-Compulsive Scale scores (pre-treatment: 25.36 ± 5.4, post-treatment: 18.43 ± 6.86) and Hamilton Anxiety Rating Scale scores (pre-treatment: 10.6 ± 3.5, post-treatment: 6.7 ± 2.7) compared to the sham TMS group. However, there was no statistically significant reduction in symmetry-related obsessive-compulsive symptoms in the TMS group compared to the sham TMS group. dTMS applied to the mPFC and ACC, using a double-cone coil at a 20-Hz frequency twice daily for three weeks, was found to be effective as an adjunctive treatment for treatment-resistant OCD.

Disruption of consciousness depends on insight in OCD and on positive symptoms in schizophrenia.

Disruption of conscious access contributes to the advent of psychotic symptoms in schizophrenia but could also explain lack of insight in other psychiatric disorders. In this study, we explored how insight and psychotic symptoms related to disruption of consciousness. We explored consciousness in patients with schizophrenia, patients with obsessive-compulsive disorder (OCD) with good vs. poor insight and matched controls. Participants underwent clinical assessments and performed a visual masking task allowing us to measure individual consciousness threshold. We used a principal component analysis to reduce symptom dimensionality and explored how consciousness measures related to symptomatology. We found that clinical dimensions could be well summarized by a restricted set of principal components which also correlated with the extent of consciousness disruption. More specifically, positive symptoms were associated with impaired conscious access in patients with schizophrenia whereas the level of insight delineated two subtypes of OCD patients, those with poor insight who had consciousness impairments similar to patients with schizophrenia, and those with good insight who resemble healthy controls. Our study provides new insights about consciousness disruption in psychiatric disorders, showing that it relates to positive symptoms in schizophrenia and with insight in OCD. In OCD, it revealed a distinct subgroup sharing neuropathological features with schizophrenia. Our findings refine the mapping between symptoms and cognition, paving the way for a better treatment selection.

Multifaceted impulsivity in obsessive-compulsive disorder with hoarding symptoms.

OBJECTIVE: Hoarding is common in obsessive-compulsive disorder (OCD), and OCD with hoarding may have poorer prognostic features than OCD without hoarding. The aim of this study was to investigate the relationship between multifaceted impulsivity and hoarding symptoms in individuals with OCD. This relationship is important to be able to understand the psychopathological mechanisms of hoarding symptoms in OCD patients. METHODS: The study included 136 individuals with OCD classified as OCD with high hoarding symptoms (OCDwHH, n = 41) and OCD with low/none hoarding symptoms (OCDwLH, n = 95), together with 94 healthy control subjects. All the participants completed the Hoarding Rating Scale-Interview, Barratt Impulsiveness Scale-11, Yale-Brown Obsessions and Compulsions Scale, Hamilton Depression Rating Scale, and Hamilton Anxiety Rating Scale. RESULTS: The OCDwHH group had more severe anxiety (p = 0.016) and attentional impulsivity (p = 0.002) than OCDwLH. Attentional impulsivity scores were positively correlated with hoarding symptom scores (p < 0.001). Both attentional and motor impulsivity scores were positively correlated with anxiety levels (p = 0.037, p = 0.045, respectively). In partial correlation analysis, motor impulsivity was positively correlated with the severity of hoarding symptoms controlling for anxiety severity (p = 0.045). In hierarchical linear regression analysis, only attentional impulsivity predicted the severity of hoarding symptoms independently of anxiety, severity of obsessive-compulsive symptoms and motor impulsivity (ß = 0.268, Adjusted R2 = 0.114, p = 0.006). CONCLUSION: Attentional impulsivity is associated with hoarding symptoms in OCD. Future studies that reveal this relationship may contribute to treatment modalities for the OCD patients with hoarding symptoms.

Obsessive Beliefs and Clinical Features in Patients with Comorbid Obsessive-Compulsive Disorder and Attention-Deficit/Hyperactivity Disorder.

Background: Obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD) are two common neuropsychiatric conditions. Obsessive beliefs, comprising the importance and control of intrusive thoughts, inflated sense of responsibility for harm, overestimations of threat, perfectionism, and intolerance of uncertainty have been suggested to influence OCD symptomatology. Although OCD patients with ADHD have been reported to have different clinical characteristics compared to patients with OCD without ADHD, it has not been previously investigated whether OCD patients with and without ADHD differ in terms of obsessive beliefs. The aim of this study was to compare the obsessive beliefs and obsessive-compulsive symptoms of OCD patients with and without ADHD. Methods: The study included a total of 197 OCD patients who were assessed with the sociodemographic data form, Wender Utah Rating Scale, Turgay's Adult ADD/ADHD Diagnosis and Evaluation Scale, The Adult ADHD Self-Report Scale, Obsessive Beliefs Questionnaire-44 (OBQ-44), Yale-Brown Obsessions and Compulsions Scale, Dimensional Obsessive-Compulsive Scale (DOCS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Results: The scores of all subscales of OBQ-44, the responsibility, unacceptable thoughts, and symmetry subscales of DOCS, BDI, and BAI scores were higher in the OCD with ADHD group than in the OCD only group. The results showed that when depression and anxiety were controlled, "the importance and control of intrusive thoughts" domain of obsessive beliefs was the unique predictor of OCD and ADHD comorbidity. Conclusion: These findings provide a better understanding of cognitive features in OCD patients with ADHD.

The effect of circadian preferences on insomnia severity and depressive symptoms via sleep hygiene in older adults with depression and healthy controls.

BACKGROUND: The elderly population is increasing globally. Thus, researches focus on the causes and treatment of insomnia, a noteworthy ageing problem. This study aims to investigate the relationship between chronotype and insomnia and whether sleep hygiene mediates this relationship in older adults with depression (OAD). METHODS: We assessed subjective insomnia severity, sleep hygiene, chronotype, depressive symptoms, and anxiety symptoms of 82 OAD and 70 healthy controls using the Sleep Hygiene Index (SHI), Insomnia Severity Index (ISI), Morningness-Eveningness Questionnaire (MEQ), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). RESULTS: The mediation effect of SHI and ISI scores were evaluated in the relationship between MEQ and BDI total scores in OAD. The results showed that MEQ performed its effect on BDI through ISI with full mediation (effect = -0.16, SE: 0.07, 95% CI: -0.3230 to -0.0336). The mediation effect of SHI and BDI scores were evaluated in the relationship between MEQ and ISI total scores in OAD. In this model, it was found that MEQ significantly performed its effect on ISI through SHI and BDI. BDI and SHI predicted the ISI variable as partial mediators (respectively, effect = -0.05, SE: 0.03, 95% CI: -0.1073 to -0.0100; effect = -0.06, SE: 0.02, 95% CI: -0.1051 to -0.0129). CONCLUSIONS: Sleep hygiene practices could be essential for the natural functioning of the biological clock and the interrelation of depression and insomnia. Longitudinal follow-up studies of structured sleep hygiene approaches are needed in terms of cost-effectiveness, in OAD.

Personality Beliefs in Obsessive-Compulsive Disorder: How Are They Related to Symptom Severity?

OBJECTIVE: The comorbidity of obsessive-compulsive disorder (OCD) and personality disorders (PDs) is frequent but there are conflicting findings about which PDs are the most common. This study aimed to investigate the personality beliefs that exist on a more pathological level among OCD patients, to explore the association between personality beliefs and OCD severity, and to clarify the mediator effect of depression in this relationship. METHODS: 202 OCD patients and 76 healthy controls with similar sociodemographic features were included in the study. The Personality Belief Questionnaire-Short Form was administered to both groups. The Yale-Brown Obsessions and Compulsions Scale, Beck Depression Inventory, and the Beck Anxiety Inventory were administered only to the clinical sample. RESULTS: The dependent, histrionic, paranoid, borderline, and avoidant personality subscale scores were significantly higher in the OCD group than in the control group. There was an association only between OCD severity and narcissistic personality beliefs, also depression mediated the relationship between narcissistic personality and OCD severity. CONCLUSION: Some personality beliefs at a pathological level are more common among OCD patients. Personality beliefs, as well as depression, should be routinely assessed, as they may affect OCD severity, help-seeking behavior, and response to treatment.

Chronotype and depressive symptoms in healthy subjects: the mediating role of hopelessness and subjective sleep quality.

Chronotype preference and lower sleep quality in university students can influence mental health. Individuals with evening chronotypes have a high risk of mental health problems, including depressive symptoms. However, the underlying mechanisms are still under investigation. Hopelessness is composed of negative feelings and thoughts about the future and is closely related to depressive symptomatology. The aim of the study was to determine whether reduced sleep quality and hopelessness mediate the association between chronotype and depressive symptoms in a student sample, which was evaluated cross-sectionally. A total of 339 Turkish students (53.7% female, mean age 22.18 ± 1.79 y) completed the Morningness-Eveningness Questionnaire, the Pittsburgh Sleep Quality Index, the Beck Hopelessness Scale, and the Beck Depression Inventory. Mediation analysis showed no significant direct relationship between eveningness and depressive symptoms. The relationship between eveningness and depressive symptoms was mediated by hopelessness, but not by subjective sleep quality (effect = - 0.03, SE: 0.01, CI: -0.04, -0.02). Better knowledge of the relationship between hopelessness and eveningness might form the basis of a more specific approach to the prevention of depression in evening types.

Effects of clipping endoscopic thoracal sympathectomy at Th4 on cardiopulmonary functions, quality of life and psychosocial functions.

BACKGROUND: In this study, we evaluated the cardiopulmonary and psychosocial effects of endoscopic thoracal sympathectomy (ETS) by clipping procedure at the level of Th4 and effects of ETS on quality of life of patients with hyperhidrosis. METHODS: We performed a prospective study in 52 patients complaining of local sweating who applied to our clinic. Cardiac maximal treadmill stress test (CMTST), pulmonary function tests, Beck anxiety-depression inventory, Liebowitz social anxiety scale and SF-36 quality of life questionnaires were administered at preoperative period and postoperative 6th month. RESULTS: In the pulmonary function test, we found a minimal decrease in FEV1, and FEV1/FVC. There were no significant change in 'resting pulse rate', 'resting systolic and diastolic blood pressures' during CMTST between before and after operation. There was a significant difference in peak heart rate before CMTST, post-exercise diastolic blood pressure, and age-predictive maximal heart rate between before and after clipping procedure. In the SF-36 questionnaire, all parameters were improved. In the Beck depression-anxiety inventory and the Liebowitz social anxiety scale significant improvement was achieved in all parameters. CONCLUSION: ETS by clipping procedure at the Th4 level is advised to be a safe and effective method for management of hyperhidrosis patients.

The relationship between internet addiction, social anxiety, impulsivity, self-esteem, and depression in a sample of Turkish undergraduate medical students.

Internet addiction (IA) is currently becoming a serious mental health problem. The aim of this study was to estimate the prevalence of IA among undergraduate medical students and evaluate the relationship of IA with social anxiety, impulsivity, self-esteem, and depression. The study included 392 undergraduate medical students. Evaluations were made with the sociodemographic data form, the Internet Addiction Test (IAT), the Liebowitz Social Anxiety Scale (LSAS), the Barratt Impulsivity Scale-11 (BIS-11), the Rosenberg Self-Esteem Scale (RSES), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). The IA group had significantly higher scores on LSAS, BDI, BAI and lower scores on RSES than the control group but the BIS-11 scores were similar among groups. IAT severity was positively correlated with LSAS, BDI, and BAI and negatively with RSES. No correlation was observed between IAT severity and BIS-11. In the hierarchical linear regression analysis, the avoidance domain of social anxiety was the strongest predictor of the severity of IA. The present study suggests that undergraduate medical students with IA exhibit higher social anxiety, lower self-esteem and are more depressed than those without IA, thus, indicating that social anxiety, rather than impulsivity, seemed to play a prominent role in IA psychopathology.

The effectiveness of cognitive behavioral group psychotherapy for obsessive-compulsive disorder.

OBJECTIVE: The aim of this study was to determine the effectiveness of cognitive behavioral group therapy (CBGT) in the treatment of the obsessive-compulsive disorder (OCD). MATERIALS AND METHODS: The study included 82 patients diagnosed as OCD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). In all, 37 patients that had their diagnosis confirmed via the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and agreed to participate were provided group therapy as 14 weekly 90-120-min sessions. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Yale-Brown Obsessive Compulsive Scale-Symptom Checklist (Y-BOCS-SC), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were administered to the patients prior to group therapy (baseline) and again after sessions 2, 5, 8, 12, and 14. RESULTS: In all, 8 patients dropped out of the study for various reasons and 29 completed the group therapy. There were significant reductions in BAI, BDI, and Y-BOCS scores in the patients that completed the group therapy. Additionally, BAI, BDI, and Y-BOCS score did not differ according to age, gender, or level of education. CONCLUSIONS: CBGT was associated with significant improvement in OCD symptoms. Neither demographic characteristics (age, gender, and education level), nor clinical characteristics (disease duration, type of obsession, compulsion type, treatment history, and comorbidity pattern) had an effect on treatment outcome. In light of these findings, we think CBGT is an effective option for the treatment of OCD.

Comparison of personality beliefs between depressed patients and healthy controls.

INTRODUCTION: According to the cognitive model, the common mechanism underlying all psychological disorders is distorted or dysfunctional thoughts that affect mood and behaviors. Dysfunctional thoughts predispose an individual to depression and are among the processes that form the basis of personality traits. Elucidating the personality beliefs associated with depression and dysfunctional thoughts is important to understanding and treating depression. The aim of the present study is to determine whether depressed patients exhibited pathological personality beliefs compared with healthy controls. Furthermore, we investigated which personality beliefs were more common among such depressed patients. METHODS: A total of 70 patients who were admitted to the Department of Psychiatry at Ankara Diskapi Yildirim Beyazit Training and Research Hospital (Ankara, Turkey) and diagnosed with major depressive disorder according to The Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnostic criteria were included in the study. Additionally, 70 healthy controls matched for age, marital status, and education were included in the study. The Sociodemographic Data Form and Personality Belief Questionnaire-Short form (PBQ-SF) were administered to the participants. RESULTS: A comparison of the depression group with the healthy controls revealed higher scores in dependent, passive-aggressive, obsessive-compulsive, antisocial, histrionic, paranoid, borderline, and avoidant personality subscales in the depressive group. CONCLUSIONS: These results suggest that personality beliefs at the pathological level are more common in depressive patients and that the detection of these beliefs would be useful for predicting the prognosis of the disease and determining appropriate treatment methods.